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Saving lives: a letter from a young physician.

After a long day's work on my internal medicine clerkship as a medical student, I waited at the sixth floor elevator at 11:00 pm. An unassuming elderly man whom I met earlier that night in the emergency room approached me. With a touch of timidity in his voice, he asked if I could spare a minute of my time. Piercing through the humility and kindness that I had come to realize were constantly present on his face were subtle expressions of anxiety and concern. He asked quietly, but in a straightforward manner, for my opinion regarding his wife.

They had come to the hospital earlier that day because she had an episode of chest pain. I made my way through the always hectic hustle and bustle of the emergency room. Phones were ringing, rooms were filled, and nurses and doctors were in constant motion. As I knocked and entered the room, the contrast was striking, and all was still. She was sitting up in the hospital bed as he sat next to her in a chair; each was reading a book, but they were very much together. The setting was one of quiet peace, the type of setting that could only take effect after years of gentle reassurances and kindnesses. I proceeded with the history and physical examination, after which I was fairly confident that she had experienced her first episode of myocardial ischemia. I explained the need for hospital admission as well as the tests and medications that needed to be administered.

It was not until later that night by the elevator that he revealed any alarm. It is my guess that he wanted to remain calm and confident for her sake, as she was probably attempting to do the same for him. In reality he was shaken, not by the day's intensity or the environment of the hospital, but by the notion that his wife of over 40 years had been threatened. As I spoke to him over the next 15 minutes, the subtle but apparent anxiety in his face began to diminish.

During those moments, my role as a future physician became very clear to me. I was able to see that medicine is about preservation. In this case, we as a medical team were striving to preserve the simple beauty of the quiet contentment of an older couple sitting together, each seemingly completed by the other's presence. As the son of a mother fighting ovarian cancer for the past 9 years, I think of my mother in a hospital bed with my father standing over her, a stoic and relentless guardian. As her disease is terminal, we have never surrendered to the hopeful delusion that the goal is to save her life. Rather, whether realized or not, her doctors are fighting for the love that has placed my father in her hospital room night after night.

I understand all too well what it is to have the harmony of a loving family threatened, to know that a most vital component may be taken away prematurely. The medical expertise doctors pursue with great vigor and intensity is the sword we wield on a battleground in which we may return individuals and families to such a harmonious and blessed abode, if only for a time. Every patient encounter is a network of human relations, and it is a privilege to be in a position in which we are sought to maintain and restore the dignity of that network. We will inevitably meet "failure" in this endeavor, but in the attempt lies the nobility of medicine. My mom has been an inspiration to me during her fight with cancer. She is simply fearless. But her battle has also been a constant reminder of our mortality. While I wish I had not learned the lesson this way, I understand that medicine is not simply about "saving lives."

J. Matt Brunson, MD

From the Department of Internal Medicine, Baylor University Medical Center, Dallas, Texas.

Corresponding author: J. Matt Brunson, MD, Resident, Department of Internal Medicine, Baylor University Medical Center, 3500 Gaston Avenue, Dallas, Texas 75246 (e-mail:
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Author:Brunson, J. Matt
Publication:Baylor University Medical Center Proceedings
Article Type:Editorial
Geographic Code:1USA
Date:Jan 1, 2009
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